Key Points
- Evaluate clinical, demographic, and pharmacological factors associated with clopidogrel initiation and adherence in patients with acute coronary syndromes undergoing percutaneous coronary intervention.
- Analyzed claims data from the US MarketScan database for 10,465 patients aged 18–65 years hospitalized for acute coronary syndromes who underwent percutaneous coronary intervention between 2005 and 2006.
- Defined adherence as a medication possession ratio of 80% or greater over follow-up.
- Conducted multivariate logistic regression analyses adjusting for patient demographics, comorbidities, and prior use of beta-blockers, statins, or angiotensin-converting enzyme inhibitors.
- Overall clopidogrel initiation was 92.8%, but only 66.8% of treated patients achieved adherence (medication possession ratio ≥ 80%).
- Decreased clopidogrel dispensing was associated with intervention without stenting (OR = 3.28), atrial fibrillation (OR = 1.91), hypertension (OR = 1.50), and diabetes (OR = 1.49; all p < 0.05).
- Significant predictors of clopidogrel non-adherence included prior clopidogrel use (OR = 1.40), prior hospitalization (OR = 1.34), intervention without stenting (OR = 1.32), chronic pulmonary disease (OR = 1.31), younger age (OR = 1.29), and diabetes (OR = 1.17).
Structured PICO
What factors are associated with clopidogrel use and adherence in patients with acute coronary syndromes undergoing percutaneous coronary intervention?
PPopulation10,465 patients aged 18-65 years hospitalized for acute coronary syndromes (ACS) and undergoing percutaneous coronary intervention (PCI) between 2005 and 2006, from a US commercial claims database.
IInterventionClopidogrel use and adherence (defined as medication possession ratio ≥ 80%)
OOutcomeFactors associated with clopidogrel use and adherence
In ACS patients undergoing PCI, while initial clopidogrel prescription rates are high, adherence is suboptimal and negatively impacted by factors such as prior clopidogrel use, diabetes, chronic pulmonary disease, and PCI without stenting.